Public Policies and Type of Insurance Are Associated With the Burden of Bladder Cancer–Related Inpatient Health Care in Chile: A Two-Decade Analysis
Abstract
Objective To quantify changes in the burden of bladder cancer (BC) inpatient health care in Chile between
2001 and 2019, focusing on the impact of public policies and the type of medical insurance (public or private)
held by patients.
Methods We retrospectively collected national data on hospital discharges and calculated raw and adjusted
hospitalization rates for the period of 2001 to 2019 categorized by sex and age. Additionally, we analyzed length of
hospital stays, outcomes of surgical interventions, and discharge conditions based on the type of medical insurance
— public: FONASA; private: ISAPRE. We also evaluated the impact of public policies such as the GES (“garantías
explícitas en salud”) program, which ensures opportunities and access to medical attention, financial protection, and
quality of care for a subset of diseases.
Results A total of 34 100 hospital discharges were analyzed. Most patients were men (71%), and median age was 69
years. Of the patients, 91.3% had some kind of medical insurance, either private or public. Within this subset, 71.3%
had public medical insurance (FONASA) and 23.2% had private medical insurance (ISAPRE). Patients on FONASA
had significantly higher levels of overall surgery-related mortality (0.83% vs. 0.2%) and significantly longer median
hospital stays (4 days vs. 2 days) compared to patients on ISAPRE. Following the implementation of the GES program
in 2013, we observed an increase in transurethral resections and a reduction in radical cystectomies among publicly
insured patients.
Conclusions The type of medical insurance has a significant impact on the burden of BC-related inpatient health
care in Chile, reflecting a significant disparity in terms of health care. The implementation of public policies such
as the GES program can play a key role in reducing this gap between public and private medical insurance systems,
especially in underdeveloped countries.
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